Extending HIV Care Beyond the Rural Health Center
Principal Investigator:
- Kara Wools-Kaloustian, M.D.,
Indiana University School of Medicine
Co-Investigators:
- Sylvester Kimaiyo, M.B.Ch.B., M.Med.,
Moi University Faculty of Health Sciences - John E. Sidle, M.D., Indiana University School of Medicine
- William M. Tierney, M.D.,
Indiana University School of Medicine
Abstract
UNAIDS estimates that 2 million of Kenya's 29.5 million people are currently infected and that 1.5 million have already succumbed to HIV. It is known that antiretroviral therapy is effective in African populations; however resources for HIV care are limited. In particular, trained medical professionals are sorely lacking in most of sub-Saharan Africa. It will be impossible to meet the needs of HIV infected patients in sub-Saharan Africa if we continue to rely on a physician and clinical officer (CO) based model for care delivery. Yet, data on alternative care delivery systems are limited.
The long term goal of our group is the development and optimization of an HIV care delivery system that will serve as a model for sub-Saharan Africa. The objective of this application is to develop and assess a system which uses non-clinician extenders to provide selected aspects of HIV care in rural western Kenya. The plan is to train persons living with HIV/AIDS (PLWAs) to undertake this role. Our central hypothesis is that PLWAs can be effective members of the health care team and that their involvement in community-based HIV care will facilitate patient access to services and improve outcomes. We base this hypothesis on four years of experience providing HIV care in western Kenya as well as our familiarity with integrating PLWAs into our HIV care system. Our group is uniquely qualified to carry out this work as Dr. Kimaiyo (Co-PI) is the Clinical Director for the AMPATH HIV Clinics affiliated with the Moi Faculty of Health Sciences (MUFHS, Eldoret, Kenya). Dr. Wools-Kaloustian, the PI, has been responsible for clinical protocol development and currently practices in one of the rural clinics. As such, our aims are:
Specific Aim 1: To develop a sustainable system to extend HIV care into the community and to train the individuals necessary to support such a system.
- Hypothesis 1a: HIV infected individuals (Community Care Coordinators) can be trained to assess and support medication adherence, monitor for adverse drug effects, trouble shoot common health and social problems, and perform simple clinical assessments for opportunistic infections among HIV infected patients in a community setting.
Specific Aim 2: To perform a randomized controlled trial to determine the impact of Community Care Coordinators (CCC) on patient adherence (to drugs and to clinic visits), clinical outcomes (i.e. viral load responses, inter-current opportunistic infections, hospitalization, drop out, change to second line therapy and mortality) and patient perception of stigma.
- Hypothesis 2a: Adherence will be better in the CCC group than in the control group.
- Hypothesis 2b: Clinical outcomes will be better in the CCC group than in the control group.
- Hypothesis 2c: Patient perceived stigma will not be greater in the CCC group than in controls.
This study will provide invaluable data on the use of non-clinician care extenders for providing HIV care in resource poor settings. If this system is found to be feasible, successful and acceptable, the CCCs will be extended to the other eight AMPATH rural HIV clinics in western Kenya. Knowledge gained from this study will assist in developing a model for non-clinician centered HIV care systems elsewhere in sub-Saharan Africa.